Download Heart failure factsheet

Heart failure factsheet
Evidence to support your
case for improved heart
failure services
We need to help patients with chronic heart failure (CHF)
to stay productive and out of hospital after they have been
diagnosed. There is overwhelming evidence that multidisciplinary heart failure care helps to manage patients
effectively. For this reason it is important for each health
service to enhance heart failure services.
What is the issue?
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Many individuals are not diagnosed with heart failure
in a timely manner, and once a diagnosis is made,
treatment is frequently sub-optimal and costing the
system unnecessarily1.
Heart failure is a chronic and complex clinical
syndrome that affects an estimated 300,000
Australians, with another 30,000 new cases diagnosed
each year2. Prevalence is known to increase with age,
reaching 10% among those aged 65 years or older
and 50% in people aged 85 years or more.
Heart failure care places a major burden on the health
care system, accounting for more than 4,000 deaths
annually.
Hospital admissions for CHF have increased by
24% between 2002-03 and 2011-123. Between
2007-08, CHF was a primary diagnosis in 45, 212
hospitalisations and a contributory diagnosis in
94, 599 hospitalisations2.
The average length of stay is 5 days within the public
sector and up to 8 days in the private sector2.
The annual cost of CHF in Australia has been
estimated at over $1 billion per year, with hospital
care being the largest expenditure4. A significant
portion of this cost is associated with preventable CHF
readmissions.
Within three to six months of initial discharge
following heart failure hospitalisation, 30-50%
of patients are rehospitalised2,5,6. Currently, there
are limited available data on a national basis, but
Victorian data highlight that readmissions within 30
days of discharge can be as high as 20%.
The 2006-07 average cost of a hospital admission in
Victoria for simple heart failure (diagnostic-related
group 62B) and complex heart failure (diagnosticrelated group 62A) was $3440 and $7260,
respectively5.
Chronic heart failure has been recognised nationally
as a potentially avoidable hospitalisation - an
admission to hospital that could have potentially been
prevented through the provision of appropriate nonhospital health services.
What do the guidelines
recommend?
• National Heart Foundation of Australia and
Cardiac Society of Australia and New Zealand
(CSANZ) guidelines for heart failure7 recommend
that people with chronic heart failure should be
educated about lifestyle changes (e.g. increase
physical activity levels, reduce salt intake,
symptoms and how to manage fluid load and
weight). They should also be supported to make
these changes, including a management plan and
routine psychosocial assessment.
• The guidelines recommend that all patients
hospitalised for heart failure should have postdischarge access to best-practice multidisciplinary
CHF care. This ensures that clinical problems are
detected and addressed proactively to manage the
disease. This also ensures that patients or carers
can control and manage symptoms, medications
are titrated as required, patients undertake
exercise training, and a pharmacy review is
conducted. Care may consist of home visits,
phone followup, clinic visits and tele-health.
Every service has a medical sponsor who is either
a cardiologist or general physician5.
• Multidisciplinary chronic heart failure care is
distinguishable from generic chronic disease
management programs by the special needs
of patients with chronic heart failure such as
ongoing medicines titration, symptom monitoring
and management of devices. This necessitates
specialised evidence-based treatment strategies
associated with optimal outcomes. Accordingly,
effective chronic heart failure care often requires
access to specialised knowledge and expertise5.
What are the benefits?
Health and clinical benefits of multidisciplinary heart
failure management7
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increased risk factor knowledge (e.g. healthy eating
and physical activity)
better symptom management (e.g. salt restriction, fluid
monitoring and fatigue action plan)
improved clinical management (e.g. blood pressure
and renal function)
Improved clinical outcomes (eg, decreased morbidity,
mortality and hospitalisations)
strengthened adherence to medications
enhanced mental health and overall quality of life
improved palliative care support and decision making
Economic benefits7
For heart health information
There is increasing evidence that multidisciplinary
guideline-based CHF failure models of care provide
large cost savings, with sustained cost benefits from early
intervention.
As the number of admissions per patient rises, so do
the associated costs for the healthcare system. There are
reliable data to suggest that up to two-thirds of CHFrelated hospitalisations are preventable. Multidisciplinary
programs have been demonstrated to significantly reduce
unplanned hospital admissions (including readmissions)
for CHF.
Intensive case management interventions led by a
specialised heart failure team, reduce heart failure related
readmissions at six months and 12 months, all cause
readmission at 12 months, and all-cause mortality at
12 months5.
For more information on heart failure models of care
download the Heart Foundation consensus statement on
heart failure5.
1300 36 27 87
How are we doing?
Since 2006, Queensland has led Australia in
implementing a systematic, coordinated, evidencebased model of care shown to improve clinical
outcomes for patients with symptomatic chronic
heart failure6. Metropolitan areas of Queensland have
world class heart failure multidisciplinary care, and
through a coordinated network, patients in rural and
regional areas are supported by tertiary and cardiac
medicine services.
• This coordinated approach has enabled continuous
quality improvement, particularly in the areas
of outreach via tele-health, medication titration,
maintaining a skilled work force through annual
training opportunities and specialist workshops, and
benchmarking of follow-up times, activity and patient
flow.
• Despite this:
• Many patients are not being referred to these
services; and
• Services in metropolitan, rural, regional and
remote areas need adequate resourcing to meet
local demands.
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www.heartfoundation.org.au
References
1.
Akosah KO, Moncher K, Schaper A, et al. Chronic heart failure in the
community: missed diagnosis and missed opportunities. J Card Fail 2001;
7(3):232-238.
2.
Australian Institute of Health and Welfare and the National Heart Foundation
of Australia. Heart, stroke and vascular diseases – Australian facts 2011.
Canberra: National Centre for Monitoring Cardiovascular Disease, 2011;
p.88.
3.
Australian Institute of Health and Welfare: Separation statistics by principal
diagnosis in ICD-10-AM Australia, 2002-03 to 2011-12.
4.
Krum H, Abraham WT. Heart Failure. Lancet 2009; 373:941-955.
5.
National Heart Foundation of Australia. A systematic approach to chronic
heart failure care: a consensus statement. Melbourne: National Heart
Foundation of Australia, 2013.
6.
Atherton JJ, Hickey A, Suna J. Striving to achieve best practice in heart failure
disease management. BMJ Qual Saf 2012; 21:263.
7.
National Heart Foundation of Australia and the CSANZ. Guidelines for the
prevention, detection and management of chronic heart failure in Australia.
Updated October 2011.